HomeMy WebLinkAboutMortgage_Gayso (3) �.rE STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township j Year
S FOR DEDUCTION FROM ASSESSE ET)
:-:•. -I: State Form 43709(R11/609)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS JUL 5 2013 Form fled with.
To be filed in person or by mail with the County Auditor or County Recorder o thct)counLty where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. aeg County Auditor
2)Mobile/Manufactured Homes not assessed as Real Pro Mus rl e twelve(12)months
before March 31 of each year the deduction is sought County Recorder
See reverse side for additio Iw�(r� tructions and qualiricaf'.ns. GIBSON COUNTY AUDITOR
AppOmnf(owner or contract _ - �; on��•r
`/
{l /1C�iia a(0-17 O�` 0DO. y-9lo-Oda Fteoard number
02D/3 Page number
3378
Assessed value af real property as of Mw Wag�on oats indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appErant the sole
March t,anent year MMarardd�i t ertpo 0 `y0 date of apptcation ❑ yes D N
U/�/1 ❑ No
If no,what is his/her exact share of interest? f If owned with someone other than spouse,indicate with whom
If name on record is different than that of appErant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or centred seller .r
Address of mortgagee or contract sooner(number a beeet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sweet,ray,state,and ZIP code) —
Does applicant own property in any other If yes,what munr✓'-- Has this deduction been requested an property
county in Indiana? ❑ Yes ❑ No i 01)k-5 tar current year? ❑ Yes
t ❑ No
Deduction approved In the amount of. / 8
20 20 20 _CaV C „•• iii _ 20 - 20
S_JI i
Signature of A UM: /tii A......._ County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
Amer I contract buyer of the aforementioned property on date application is filed.
( hre ) o� Date(month,day.year)
�. /�
6u0 resident address of applicant(number and street city. ,and ZIP code)
tN_ 9/ AI -3,P /t n°i+-✓J-rir� / to `/9EA.r
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Person authorized by duly executed Power of or IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .